New Insulin Cap Bill Lauded, But Caution Urged

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A bipartisan Senate bill, Affordable Insulin Now Act of 2023, would require plans to cover insulin for no more than $35 per month.

A new bill to cap the price of insulin for all patients — insured or uninsured — was praised by a nonprofit healthcare group, while it also urged caution. Senators John Kennedy (R-LA) and Raphael Warnock (D-GA)’s Affordable Insulin Now Act of 2023 would cap the price of insulin for all patients at $35 for a 30-day supply.

The legislation follows announcements by the three major insulin manufacturers — Lilly, Novo Nordisk and Sanofi — to lower insulin prices.

The new Affordable Insulin Now Act of 2023 would require private group or individual plans to cover one of each insulin dosage form (vial, pen) and insulin type (rapid-acting, short-acting, intermediate-acting, and long-acting) for no more than $35 per month, Kennedy and Warnock’s offices said.

It would also require the Secretary of Health and Human Services to establish a program to reimburse qualifying entities for covering any costs that exceed $35 for providing a 30-day supply of insulin to uninsured patients.

“By making preventive care more accessible, this bill would reduce long-term health care costs for individual patients, avoid devastating complications from diabetes and take pressure off the entire health care system,” Kennedy said in a statement.

Timothy A. Lash

Timothy A. Lash

While Timothy A. Lash, president of West Health, a nonprofit and nonpartisan organization focused on aging and healthcare, praised the legislation he also urged caution.

“It’s important that any new legislation address both the cost of insulin to patients and the total cost to the healthcare system. Legislation that caps the price of insulin for all should be designed to ensure a reduction in the total spend on current and future insulin products rather than cost shifting to the benefit of drug plans and Big Pharma,” Lash said.

Insulin is a 100-year-old drug with a patent that was sold for $1, Warnock noted. “No one should feel forced to put their health or life in danger because they can’t afford their insulin. We have the momentum—let’s get this done,” Warnock said.

Medical costs and lost work and wages for people with diagnosed diabetes total $327 billion yearly, according to the CDC, and the American Diabetes Association has asserted that diabetics account for $1 of every $4 spent on healthcare in the United States. In addition, a national study projected that improving access to insulin for uninsured patients could help avoid complications of diabetes and deaths related to the disease.

“As a result, the healthcare system could save substantial amounts of money on providing care to uninsured diabetes patients,” the legislators’ offices said.

Several state legislators have also introduced bills that cap insulin prices in their states. For example, Senate Bill 90, introduced by Senator Scott Wiener (D) would prohibit state-regulated health insurance plans from imposing a deductible on those prescriptions and capping the copay at $35 for a 30-day supply. The current copay limit is $250, per Cal Matters.

Meanwhile, California Governor Gavin Newsom, as part of his tour of the State of California, announced a contract with generic manufacturer, Civica, to make the most commonly used short- and long-acting insulins that will be offered at prices of $30 a vial and $55 for a box of five pre-filled pens. The move will bring down the price of insulin by about 90%, saving cash-paying patients between $2,000 and $4,000 annually, Newsom said.

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